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Questions and Answers
Which of the following tests is primarily associated with diagnosing Sjogren’s Syndrome?
An elevated Rheumatoid Factor (RF) test primarily suggests which of the following diseases?
Which test is specifically indicated if Antinuclear Antibodies (ANAs) result is positive?
What is the primary disease associated with the HLA-B27 antigen?
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An Anti-neutrophil cytoplasmic antibody (ANCA) test is predominantly associated with which condition?
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Which laboratory test is used to monitor inflammation across various autoimmune conditions?
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Anti-citrullinated protein antibodies are primarily associated with which autoimmune disorder?
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Which test is not directly associated with Lupus?
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What is the primary method for annual screening of hydroxychloroquine retinopathy after 5 years of drug use?
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Which of the following is NOT included in the ineffective testing methods for hydroxychloroquine retinopathy?
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Which diagnostic criteria is NOT associated with Giant Cell Arteritis (GCA)?
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What clinical symptom is typically present in Arteritic Anterior Ischemic Optic Neuropathy (AAION)?
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For patients with systemic lupus erythematosus (SLE), which statement about ocular effects is correct?
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In diagnosing Sjogren’s Syndrome (SS), which point value is assigned to a positive anti-Ro/SSA test?
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What is a key treatment consideration in managing AAION caused by GCA?
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Which laboratory value is crucial in diagnosing GCA when using the ESR method?
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What is the recommended approach for the monitoring of patients with GCA after starting treatment?
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Study Notes
Autoimmune Disorders
- Autoimmune Disorders occur when the body's immune system attacks its own tissues.
- They are diagnosed through laboratory tests, particularly by identifying specific antibodies in the blood.
- The most common tests used to diagnose autoimmune disorders include Rheumatoid Factor (RF), Anti-citrullinated protein antibodies (ACPAs or anti-CCPs), Antinuclear antibodies (ANAs), Anti-double stranded DNA antibodies (anti-dsDNA), Anti-neutrophil cytoplasmic antibody (ANCA), Erythrocyte Sedimentation Rate/C-Reactive Protein (ESR/CRP), and Human Leukocyte Antigen B27 (HLA-B27).
- Treatment generally involves medications like hydroxychloroquine, steroids, or biologics to suppress the immune system.
Hydroxychloroquine Retinopathy Testing Guidelines
- Baseline eye exam within 1 year of starting hydroxychloroquine
- Annual screening starting after 5 years of use, unless maculopathy or major risk factors are present
- More frequent screening if maculopathy or major risk factors present
- Primary Testing: automated visual fields (10-2 White Light or 24-2 for Asian patients), OCT of the macula, Dilated fundus exam
- Adjunctive Testing: Multifocal ERG, Fundus autofluorescence
- Ineffective Testing: Fluorescein angiography (FA), Full-field ERG, EOG, Amsler grid, Color vision testing
Giant Cell Arteritis (GCA)
- GCA is a serious condition characterized by inflammation of the temporal artery.
- GCA commonly affects people over 50 years old, causing a sudden, severe headache, tenderness to palpation of the temporal artery, elevated Erythrocyte Sedimentation Rate (ESR), and abnormal temporal artery biopsy (TAB) features.
- Diagnosis requires the presence of at least four of the following criteria: age > 50, new headache, tenderness or decreased pulsation of temporal artery, ESR ≥50 mm/hr, abnormal TAB.
- Oral or IV steroids are the primary treatment, with a taper over months to years.
Arteritic Anterior Ischemic Optic Neuropathy (AAION)
- AAION is a sudden and severe loss of vision caused by inflammation of the artery supplying the optic nerve.
- Visual field defects primarily affect the periphery.
- Treatment consists of high doses of steroids to prevent vision loss in the other eye. Since the optic nerve is damaged, visual recovery in the affected eye is rarely complete.
Systemic Lupus Erythematosus (SLE)
- SLE is a chronic autoimmune disease that can affect various organs, including the skin, joints, kidneys, heart, lungs, and brain.
- SLE commonly causes fatigue, joint pain, skin rashes, and photosensitivity.
- Diagnosing SLE requires the presence of at least four out of eleven criteria, such as malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurological disorder, hematological disorder, immunologic disorder, and antinuclear antibody (ANA).
Ocular Effects of Lupus
- Eye involvement in SLE, known as lupus retinopathy, can cause retinal vasculitis and retinal hemorrhages.
Rheumatoid Arthritis (RA)
- RA is a chronic autoimmune disorder that primarily affects the joints, leading to inflammation, pain, stiffness, and joint damage.
- The diagnosis requires the presence of four out of seven criteria, such as morning stiffness lasting at least one hour, arthritis involving three or more joints, arthritis of hand joints, symmetrical joint involvement, rheumatoid nodules, positive rheumatoid factor (RF), and radiographic changes characteristic of RA.
Ocular Effects of RA
- RA can cause scleritis, episcleritis, keratoconjunctivitis sicca, and corneal melting.
Sjogren's Syndrome (SS)
- SS is a chronic autoimmune disorder that primarily affects the exocrine glands, including the salivary and lacrimal glands.
- It causes dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca).
- Symptoms include dry eyes, dry mouth, oral ulcers, fatigue, and joint pain.
- Diagnosis requires the presence of four points from the following: positive Anti-Ro/SSA antibodies (3 points), lip biopsy showing Focus > 1 foci/4mm^2 (3 points), ocular staining score ≥ 5 (1 point), Schirmer’s test (without anesthetic) ≤ 5 mm/5 min (1 point), and unstimulated salivary flow rate ≤ 0.1 mL/min (1 point).
SS Management
- Treatment often includes artificial tears, saliva substitutes, and medications that stimulate saliva production.
Spondyloarthropathies (SpA)
- SpA is a group of inflammatory diseases that primarily affect the spine and the sacroiliac joints.
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Description
This quiz explores the nature of autoimmune disorders and the guidelines for testing hydroxychloroquine retinopathy. Discover how the immune system can attack the body, the diagnostic tests involved, and the recommended screening practices for patients using hydroxychloroquine. Test your knowledge on these critical health topics.
